Nonconforming gender expression and adolescent anabolic-androgenic steroids misuse.

BACKGROUND: Gender nonconformity (GNC) is an under-researched area of adolescent health that is of increasing interest to researchers and general public. However, little is known about whether it is associated with anabolic-androgenic steroids (AAS) misuse. We aimed to investigate the association among high school students using a cross-sectional design. METHODS: We pooled the 6 school districts data from the Youth Risk Behavior Survey in 2017 and 2019. We compared the prevalence of AAS misuse among gender nonconforming and conforming students. AAS misuse was determined on the reported experience of lifetime non-prescription steroid use. GNC was derived from perceived gender expression and sex. We estimated the sex-stratified adjusted odds ratios (AORs) for the association of GNC with AAS misuse after adjusting for race/ethnicity, grade, and sexual orientation. RESULTS: The study population consisted of 17,754 US high school students including 9143 (49.67%) female students. Among female students, GNC was significantly associated with moderate (AOR, 3.69; 95% CI 1.28-10.62; P = 0.016) and severe (AOR, 5.00; 95% CI 1.05-23.76; P = 0.043) AAS misuse, but not with any AAS misuse (AOR, 0.85; 95% CI 0.34-2.14; P = 0.734). Among male students, GNC was significantly associated with any (AOR, 4.75; 95% CI 2.93-7.69; P < 0.001), moderate (AOR, 4.86; 95% CI 2.66-8.89; P < 0.001) and severe (AOR, 4.13; 95% CI 1.43-11.95; P = 0.009) AAS misuse. We did not observe a dose-response relationship between GNC and any AAS misuse in female and male students. CONCLUSIONS: This study suggests that AAS misuse is associated with GNC among female and male adolescents.

Analysis of factors influencing elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa City / 中国学校卫生

Objective@#To explore the prevalence of elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa, and to analyze their association with lifestyle and other factors, so as to provide a basis for the intervention measures targeting elevated blood pressure, overweight and obesity among middle school students in high altitude area.@*Methods@#Using a stratified cluster random sampling method in September 2021, a total of 1 488 Tibetan junior and high students from Lhasa City were investigated with blood pressure measurement, physical examination and questionnaire survey. The influencing factors of elevated blood pressure, overweight and obesity and their comorbidities association were analyzed by multivariate Logistic regression.@*Results@#The prevalence of elevated blood pressure, overweight/obesity and their comorbidities were 17.8%, 17.4% , 5.0% respectively. Multivariate Logistic regression analysis showed that age( OR =0.81), residence, body mass inex(BMI) and gender were the influencing factors of elevated blood pressure; and the risks of elevated blood pressure in female students were higher than male students ( OR =1.89), suburban students were higher than urban students ( OR =8.06), overweight and obesity groups were higher than normal groups ( OR =2.55, 2.87) ( P <0.05). Adjusting for confounding factors such as gender, residence and school, and BMI (only for elevated blood pressure), daily screen time ≥2 h was positively correlated with elevated blood pressure, overweight/obesity and its comorbidities ( OR =1.56, 1.59 , 2.51) ( P <0.05).@*Conclusions@#The prevalence of elevated blood pressure, overweight/obesity are relatively high in Lhasa. Longer screen time is a common factor affecting with elevated blood pressure, overweight/obesity and comorbidities among Tibetan students. Measures should be taken intervene in the lifestyle of Tibetan students, in order to reduce elevated blood pressure and overweight/obesity.

Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study.

BACKGROUND: Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. METHODS: A cross-sectional survey was carried out among 473 unmarried youth aged 15-24 with visual, hearing, physical disabilities in both urban and rural areas in China. RESULTS: Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. CONCLUSION: Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities.

Youth with disabilities have the same sexual and reproductive health (SRH) needs as their peers without disabilities and the equal right to attain the highest standard of SRH. However, their SRH needs and rights are often overlooked or neglected. Studies on SRH among unmarried youth with disabilities are very limited in China. This study used data collected from 473 unmarried youths with different types of disabilities from both urban and rural areas in China, to understand their SRH knowledge and its associated factors, as well as barriers and preferences in accessing sexuality-related information. This study demonstrated that unmarried youth with disabilities lacked knowledge of SRH, especially those with hearing or physical disabilities and those from rural areas. In general, residential area and education level were significant correlates of knowledge among respondents. Sources of and barriers and preferences in accessing SRH information varied across types of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of knowledge, followed by the Internet, peers and parents. Unaware of the available sources of accurate information and feeling embarrassed to seek information were the most frequently mentioned barriers in accessing SRH information. The findings of the study highlight the need to reduce the barriers to sexuality education for unmarried youth with different types of disabilities. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities and empower them to seek information proactively.

A Small Surge in Incidence of SARS-CoV-2 Omicron Variant in the "Dynamic Zero" Period.

To describe the epidemiological characteristics and transmission dynamics of SARS-CoV-2 Omicron variant during "Dynamic Zero" period, we analyzed data on the 108 laboratory-confirmed SARS-CoV-2 cases during 14 to 30 May 2022 in Beichen district, Tianjin, China. We collected information on demographic characteristics, exposure history, and illness timelines of the 108 cases. We described characteristics of the patients and estimated the key epidemiological parameters, including serial interval and the time-dependent reproduction number of the Omicron variant, Rt. Among the 108 laboratory-confirmed patients, the median age was 38 years old, and 50.9% were females. Obvious symptoms were observed among 67.6% (73/108) of all cases, and major clinical manifestations included fever, sore throat, and cough, which occurred in 31.5%, 26.9%, and 19.4% of the 108 cases, respectively. The mean and standard deviation of the SI were estimated as 2.89 and 0.95 days, the Rt varied from 1.24 to 0.27 for a 7-day timelapse. The low reproduction number and the Omicron outbreak being suppressed within a short time marked the effectiveness of the implemented public health measures, such as nucleic acid screening, social distancing, masking, vaccination, medical treatment of patients, and isolation of close contacts. These measures play an important role in fulfilling the goal of controlling the spread of the disease.

Early physical maturation and subjective health complaints in adolescent girls: a pooled cross-sectional analysis.

BACKGROUND: Although adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of psychosomatic symptoms and how this association varies between countries. METHODS: Our sample included 298 000 adolescent girls from 2002, 2006, 2010 and 2014 cycles of the Health Behaviour in School-aged Children (HBSC) study in 41 European and North American countries. School surveys measured the frequency of eight psychosomatic symptoms in the past 6 months. Early maturation was defined as self-reported age at menarche below 11 years. Using logistic regression, we estimated adjusted ORs (aORs) and 95% CIsof experiencing each psychosomatic symptom at least more than once a week and experiencing two or more symptoms at least more than once a week. RESULTS: Early menarche occurred in 4.73% of the sample and was positively related to headache, stomachache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties in sleeping, feeling dizzy and two or more of these symptoms, respectively (all p values<0.001). The interactions between early menarche and survey circle were non-significant. Changing the age criterion to 12 years did not affect the results. The associations between early menarche and psychosomatic symptoms were robust across the HBSC-participating counties with two age criteria. CONCLUSIONS: Early menarche positively relates to various psychosomatic symptoms in European and North American adolescent girls. Our findings suggest that early-maturing girls may need early supportive interventions.

Relationship between body image satisfaction and adverse childhood experiences in adolescents / 中国学校卫生

Objective@#To explore the relationship between body image and adverse childhood experiences (ACEs) in adolescents.@*Methods@#A total of 1 701 adolescents in grade 6-8 in three middle schools in Shanghai were selected by stratified cluster sampling, and were investigated anonymously using computer assisted self interview approach. Information including demographic characteristics, body image satisfaction, and ACEs were collected. The Chi square test and multivariate Logistic regression were used to explore the relationship between adolescent body image satisfaction and types of ACEs.@*Results@#About 60.73% of the respondents were satisfied with their body image, with higher satisfaction among boys(66.16%) than among girls(55.13%)( χ 2= 21.70 ， P <0.01). About 79.19% of the respondents had experienced at least one ACE, and respectively 61.61%, 65.14% and 21.58 % of them had experienced abuse, neglect and family dysfunction. Multivariate Logistic regression analysis indicated that experiencing at least one ACE, abuse, neglect and family dysfunction were all related with low body image satisfaction among girls( OR =0.33- 0.57 , P <0.01), while among boys neglect,having 3 or more than 4 ACEs were found to be associated with body image satisfaction ( OR =0.54-0.64, P <0.05). The cumulative effects of ACEs on adolescent body image were observed.@*Conclusion@#Different types of ACEs are associated with body image in adolescents, ACEs have cumulative effects on adolescent body image, which shows gender differences.Screen of ACEs and improvement of family nurturing environment should be highlighted among adolescents, especially among girls.

Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study.

BACKGROUND: Prophylactic antibiotic use during delivery is common in routine obstetric practice to prevent infection globally, especially in low- and middle-income countries. In China, however, little is currently known about the national estimates for prophylactic antibiotic use during delivery. Therefore, we aimed to describe the prevalence of prophylactic antibiotic use and guideline adherence using national data in China. METHODS: This cross-sectional study analyzed a national dataset from the China Labor and Delivery Survey in 2015-2016. The primary outcomes were prophylactic antibiotic use and clinician adherence to WHO recommendations for the prevention and treatment of maternal peripartum infections. We estimated the weighted prevalence of the outcomes with Taylor series linearization and investigated the associated factors of the outcomes with logistic regression. RESULTS: Of the 72,519 deliveries, the prevalence of antibiotic prophylaxis was 52.0%, varying from 92.8% in Shanxi to 17.3% in Hainan. The prevalence of clinician adherence to the WHO guideline was 79.9%, ranging from 93.4% in Shandong to 50.0% in Shanxi. Prophylactic antibiotic use was associated with cesarean delivery (AOR, 55.77; 95%CI, 25.74-120.86), operative vaginal delivery (AOR, 4.00; 95%CI, 1.64-9.78), preterm (AOR, 1.96; 95%CI, 1.60-2.41), premature rupture of membranes (PROM) (AOR, 2.80; 95%CI, 1.87-4.18), and meconium-stained amniotic fluid (AOR, 1.91; 95%CI, 1.30-2.81) in all deliveries and also episiotomy (AOR, 1.48; 95%CI, 1.02-2.16) in vaginal deliveries. Clinician adherence was positively associated with cesarean delivery (AOR, 5.72; 95%CI, 2.74-11.93) while negatively associated with operative vaginal delivery (AOR, 0.26; 95%CI, 0.11-0.61), PROM (AOR, 0.50; 95%CI, 0.35-0.70), and meconium-stained amniotic fluid (AOR, 0.66; 95%CI, 0.48-0.91) in all deliveries. In vaginal deliveries, clinician adherence was negatively associated with episiotomy (AOR, 0.67; 95%CI, 0.46-0.96) and severe perineal trauma (AOR, 0.09; 95%CI, 0.02-0.44). Besides, clinicians in general hospitals prescribed prophylactic antibiotics more likely (AOR, 2.79; 95%CI, 1.50-5.19) and had a lower adherence (AOR, 0.38; 95%CI, 0.20-0.71) than their peers in maternity hospitals. CONCLUSIONS: We observed that about half of all deliveries in China received antibiotics for prophylaxis, and most deliveries were prescribed according to the WHO guideline. Furthermore, the two prevalence rates for prophylactic antibiotic use and clinician adherence varied widely across provinces of China.

Nonconforming gender expression and insufficient sleep among adolescents during COVID-19 school closure and after school reopening.

BACKGROUND: Gender nonconformity (GNC) (i.e., gender expression that differs from gender role expectations for feminine or masculine appearance and behavior) is an under-researched area of adolescent sleep health. The COVID-19 lockdown offers an opportunity to understand how the effect of GNC on adolescent health outcomes changes between school closure and reopening. METHODS: We conducted a cross-sectional study in Shanghai, China, in 2020. The sample size for analysis was 3,265. The age-specific insufficient sleep was estimated according to National Sleep Foundation's sleep duration recommendations. The self-perceived and self-rated GNC were measured by the two items "On the same scale that goes from 100% as a girl to 100% as a boy, where do you think others see you?" and "On a scale that goes from feeling 100% like a girl to feeling 100% like a boy, where do you see yourself?", and birth sex. In addition, we calculated sex-stratified adjusted odds ratios (AORs) of insufficient sleep for students with high and moderate GNC compared to students with low GNC. Finally, we measured the AORs with self-perceived and self-rated GNC during COVID-19 school closure and reopening. RESULTS: Among 3,265 students in grade 6-12 in the analytic sample, 1,567(48.0%) were assigned female at birth (AFAB), 3,188 (97.6%) Han, and 1,921(58.8%) in grade 6-9. Among AFAB students, high self-perceived GNC was significantly associated with insufficient sleep (AOR,1.65; 95%CI,1.30-2.09) during school closure. Insufficient sleep was associated with high self-rated GNC (AOR,1.73; 95%CI,1.23-2.44) and moderate self-rated GNC (AOR,1.69; 95%CI,1.29-2.22) during school closure. After school reopening, neither self-perceived nor self-rated GNC was associated with insufficient sleep among AFAB students. Among assigned male at birth (AMAB) students, none of the two kinds of GNC was associated with insufficient sleep in the two periods during the COVID-19 pandemic. CONCLUSIONS: This study suggests GNC is only associated with insufficient sleep among AFAB students during school closure. Furthermore, the association is nonsignificant among AMAB students. These findings indicate that GNC-related stigma within the family could be a risk factor for insufficient sleep among AFAB adolescents.

Comparing the Perceptions of Gender Norms among Adolescents with Different Sibling Contexts in Shanghai, China.

Individuals' gender development is influenced by the characteristics of personal and contextual environments. However, the role of sibling contexts in shaping gender norms has rarely been studied among Chinese youth at early adolescence as most of them were the only child. The aim of this paper is to compare perceived gender norms among adolescents aged 10-14 with different sibling configurations, to help inform and tailor guidance for sexual and reproductive health education in the future. We used the Global Early Adolescent Study baseline data collected from Shanghai, China. The sample for analysis was 1615 students. We used univariate analysis and multivariate ordinal logistic regression to compare perceived gender-stereotyped traits and gender role attitudes, stratified by age and sex. The results showed that sibling context was more influential for boys than girls at early adolescence in their gender socialization process. Among boys those who were with mixed-sex siblings scored higher on gender-stereotyped traits (ORonly-childvs. mixed-sex siblings = 0.67, 95% CI: 0.48-0.94, p = 0.019; ORsame-sex siblingsvs. mixed-sex siblings = 0.59, 95% CI: 0.37-0.96, p = 0.033). Younger early adolescents aged 10-12 who were the only child or who had mixed-sex siblings perceived more traditional gender role attitudes than those living with same-sex siblings (ORonly-childvs. same-sex siblings = 1.71, 95% CI: 1.06-2.75, p = 0.028; ORmixed-sex siblingsvs. same-sex siblings = 1.74, 95% CI: 1.03-2.94, p = 0.037). Comprehensive sexuality education with gender and power components being well addressed, both in and out of the family, is needed to provide extra gender-inclusive and gender-egalitarian environments for youth.

Sexual-Related Knowledge, School and Family Sexuality Education and Its Association with Experience of Sexual Intercourse among Vocational Secondary School Students in China.

OBJECTIVES: To investigate the associations between sexual-related knowledge, access to school and family sexuality education, and the experience of sexual intercourse, in order to make recommendations on sexuality education for vocational secondary school students in China. METHODS: A cross-sectional study was conducted among 3180 vocational secondary school students in the Shanghai municipality and the Shaanxi province, China. Data were collected through an online, electronic questionnaire, which included socio-demographics, sexual-related knowledge, sources of information, and sexual-related behaviors. RESULTS: The score on sexual-related knowledge among girls (53.8) is higher than that of boys (48.8), and that of participants from Shanghai (55.2) is higher than their counterparts from Shaanxi (47.6). The proportions of girls (70% and 41.7%, respectively) and participants from Shanghai (65% and 35.7%, respectively) who reported acquiring sexual information from their schools/teachers and parents are higher than that of boys (54.3% and 21.0%, respectively) and their counterparts from Shaanxi (59.7% and 27.4%, respectively). About 6% of participants had experienced sexual intercourse and 10% had watched porn actively. Experience of sexual intercourse was associated with higher sexual-related knowledge scores (OR = 1.01, 95% CI: 1.00-1.02) and active porn watching (OR = 2.63, 95% CI: 1.79-3.84) but was not associated with school and family sexuality education. CONCLUSIONS: Vocational secondary school students had poor sexual knowledge and inadequate school and family sexuality education. School and family-based comprehensive sexuality education should be promoted among vocational secondary school students.

Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization.

Gender dissatisfaction is often linked to adverse health outcomes and is an under-researched area of adolescent health. The aim of our study was to examine the associations of gender dissatisfaction with adolescent mental distress and sexual victimization. We conducted a cross-sectional study in April 2019 using a computerized self-administered questionnaire to collect data on the gender dissatisfaction, mental distress, and sexual victimization among Chinese adolescents. We used multivariate logistic models to estimate sex-stratified adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the associations of gender dissatisfaction with mental distress and sexual victimization. Our study involved 538 female and 556 male students from grades 7 to 11. Among the female students, gender dissatisfaction was significantly associated with depression (AOR, 2.04, 95%CI, 1.17-3.58), anxiety (AOR, 2.13, 95%CI, 2.00-2.27), suicidal ideation (AOR, 2.36, 95%CI, 2.02-2.76), sexting victimization (AOR, 1.67, 95%CI, 1.11-2.51), and nonphysical sexual harassment (AOR, 1.72, 95%CI, 1.08-2.76). Among the male students, gender dissatisfaction was significantly associated with oral--genital contact (AOR, 5.86, 95%CI, 2.74-12.54), attempted sexual assault (AOR, 9.63, 95%CI, 6.91-13.42), and completed sexual assault (AOR, 14.71, 95%CI, 1.16-187.33). Our findings suggest gender dissatisfaction is associated with adolescent mental distress and sexual victimization, underscoring the importance of implementing comprehensive sexual education with gender perspectives in China.

Parenting Practice Profiling and Its Associated Factors among Secondary Vocational School Students in China.

BACKGROUND: Parenting styles have a tremendous influence on a child's development and behavior. Studies on parenting styles using latent profile analysis have been increasing in recent years. However, there are few such studies conducted in China, especially concerning joint parenting styles (that simultaneously characterize maternal and paternal practices), which are held over the age group of secondary vocational school students. This study aimed to identify the profiles of parenting styles and their associated factors among the parents of secondary vocational school students in China, based on natural samples and not a predetermined model. METHOD: Data were drawn from a cross-sectional study conducted among 3180 students from six secondary vocational schools in Shanghai Municipality and Shaanxi Province. A total of 2392 students who have lived with their parents for most of their lifetime were included in the study. Latent profile analysis was used to identify the profiles of parenting styles of the respondent's parents. Multinominal logistic regression models were used to examine the association between parenting style and demographic characteristics and family background and adolescent outcomes. RESULTS: We identified five latent profiles: "free-range parenting" (27.05%), "behavioral monitoring parenting" (33.65%), "authoritative parenting" (11.75%), "psychological control parenting" (14.38%) and "tiger parenting" (13.17%). The associations between these profiles and adolescent outcomes indicated that these profiles were rational. Participants' gender, grade, residential area, family economic level, parental marital relationship, and parental educational level were predictive factors for parenting styles. CONCLUSIONS: The parenting styles held over secondary vocational school students were somewhat different from Baumrind's parenting style model. A considerable number of students received a parenting style that might predispose them to behavioral and mental health outcomes and merit a tailored intervention using the predictive factors of parenting styles.

Associations of nonconforming gender expression and gender identity with bullying victimization: an analysis of the 2017 youth risk behavior survey.

PURPOSE: Although gender nonconformity (GNC) and transgender identity are both linked to bullying victimization, few studies have examined them with bullying victimization simultaneously. Using a sample of Youth Risk Behavior Survey, we investigated the associations of GNC and transgender identity with bullying victimization within the same study. METHODS: We analyzed data from the cross-sectional school-based Youth Risk Behavior Survey in 2017 (n = 25,378). The exposures were GNC and transgender identity. The main outcomes were traditional victimization, cyber victimization, and combined victimization. We calculated adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) using Poisson regression models. RESULTS: There were 22.15% of high school students with GNC, and 1.61% identified themselves as transgender. GNC is associated with traditional (APR,1.45;95%CI, 1.21-1.73), cyber (APR,2.00; 95%CI, 1.66-2.40) and combined victimization (APR,1.61;95%CI, 1.42-1.83) respectively among assigned male at birth (AMAB) students only. Transgender male and female students are both at higher risk of bullying victimization for all the three outcomes than cisgender peers. CONCLUSIONS: AMAB GNC and transgender identity are associated with a higher risk of bullying victimization. Providing support systems and celebrating gender diversity within and outside schools are important.

Association between sexting and mental health among secondary vocational school students / 中国学校卫生

Objective@#To explore the prevalence of sexting among secondary vocational school students and to examine the correlation between sexting and mental health, so as to provide evidence for prevention and intervention on adolescents mental health.@*Methods@#In April 2021, three secondary vocational schools from central urban area, outskirts and outer suburbs in Shanghai, among 1 580 students were selected by cluster sampling.@*Results@#The proportions of students who received and who forwarded others private photos or videos were 11.96% and 2.78%, respectively. The proportion of students who sent others personal photos or videos was 2.54%. And the proportions of boys were higher than those of girls ( χ 2=45.89, 24.09, 6.66, P <0.01). The results of multivariable Logistic analysis showed that compared with those who had never sexted, students who had ever had any sexting were at higher risk of anxiety ( OR=2.40, 95%CI =1.59-3.61), depression( OR=1.86, 95%CI =1.25-2.75), non suicidal self injury intention ( OR=2.34, 95%CI =1.48-3.69) and suicidal intention ( OR=2.96, 95%CI =1.83-4.79)( P < 0.05 ).@*Conclusion@#There is a significant correlation between sexting and mental health among secondary vocational school students. The latent risks of sexting should be included in the curriculum of comprehensive sex education for teenagers to enhance their media literacy and decision making capability, so as to prevent sexual assault or abuse caused by sexting and promote sexual and reproductive health and as well as mental health of adolescents.

Relationship between gender role attitudes and depression among adolescents / 中国学校卫生

Objective@#To explore the relationship between gender role attitudes (GRA) and adolescent depression to provide evidence for the promotion of mental health among adolescents.@*Methods@#A total of 1 549 students from grades 6 to 8 in three public middle schools in Jing an District of Shanghai were selected by stratified cluster sampling. The baseline and follow up surveys were conducted by anonymous electronic questionnaire on mobile tablets from November to December in 2017 and 2018, respectively. The GRA Scale and the Depression Scale were used to collect subjects attitudes towards traditional role assignment and power inequality between men and woman and depression in family and sexual relationships. The multivariate Generalized Estimating Equations (GEE) model was adopted to examine the relationship between GRA and depression.@*Results@#The mean score of the GRA Scale was (2.52±0.83) and (2.29±0.86), while the score of Depression Scale was (15.92±5.08) and (16.48±5.29), in the baseline and follow up survey, respectively ( P <0.05). After controlling the covariates of age, bullied experience, body image, social cohesion, etc., the multivariate GEE model indicated traditional GRA was significantly associated with a higher risk of depression among both boys and girls ( β boys =0.38, β girls =0.41, P <0.05).@*Conclusion@#Traditional GRA may increase the risk of depression in adolescents, suggesting that cultivating a positive and equal GRA among this population group may help to prevent depression.

Grade repetition and bullying victimization in adolescents: A global cross-sectional study of the Program for International Student Assessment (PISA) data from 2018.

BACKGROUND: Grade repetition is practiced worldwide and varies considerably across the globe. Globally, around 32.2 million students repeated a grade at the primary education level in 2010. Although a large body of research has documented grade repetition's academic and non-academic effects, the limited evidence on associations between grade repetition and school bullying is inconsistent and ambiguous. This study aimed to investigate the global association of grade repetition with bullying victimization in a large-scale school-based cross-sectional study. METHODS AND FINDINGS: We used the latest global data from the Program for International Student Assessment (PISA) 2018. PISA 2018 was conducted between March and August 2018 in 80 countries and economies among students aged 15-16 years attending secondary education. The students reported their experiences of repeating a grade at any time point before the survey and of being bullied in the past 12 months. The outcome measures were 6 types of bullying victimization. We accounted for the complex survey design and used multivariate logistic regression models to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of grade repetition with bullying victimization after adjusting for potential confounders (sex; age group; migrant status; school type; economic, social, and cultural status; and parental emotional support). This study included 465,146 students (234,218 girls and 230,928 boys) with complete data on grade repetition and bullying victimization in 74 countries and economies. The lifetime prevalence of grade repetition was 12.26%, and 30.32% of students experienced bullying at least a few times a month during the past 12 months. Grade repetition was statistically significantly associated with each type of bullying victimization. The OR (95% CI) of overall bullying victimization for grade repeaters compared with their promoted peers was 1.42 (95% CI 1.32-1.52, p < 0.001). The sex-specific analysis produced similar results in both boys and girls. Furthermore, girls who repeated a grade had higher risks of being made fun of, being threatened, having possessions taken away, and being pushed around than boys. The major limitation is that this study only included students attending schools and therefore may be subject to possible selection bias. In addition, the cross-sectional design hinders us from establishing causality between grade repetition and bullying victimization. CONCLUSIONS: In this study, we observed that, globally, both boys and girls who repeat a grade are at increased risk of being bullied compared with promoted peers, but girls may experience higher risks than boys of specific types of bullying associated with repeating a grade. These findings provide evidence for the association of grade repetition with bullying victimization. Sex differences in risk of experiencing some types of bullying suggest that tailored interventions for girls who repeat a grade may be warranted.

The pattern of romantic and sexual related experiences among Chinese young adolescents: an exploration with multi-group latent class analysis.

BACKGROUND: Studies on very young adolescents' romantic and sexual experiences would help inform the context in which early sex arises. However, such studies are scant in China due to sparse data and cultural issues. METHOD: This study used the GEAS baseline data conducted among1776 adolescents in Shanghai. Multi-group latent class analysis was used to explore adolescents' romantic and sexual experiences patterns and subgroups. Multi-nominal logistic regression was performed to identify the factors distinguishing different subgroups subsequently. RESULTS: There were gender differences in the lifetime prevalence for very young adolescents' romantic and sexual-related behaviors. The Multi-group latent class analysis indicated that the participants could be classified into three classes: general group, early romance group, and sex exploratory group. Multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both gender, ever had a romantic relationship, and had more autonomy in deciding where to go than the general group; while male respondents in the sex exploratory group were older, ever had a romantic relationship, believed that boys should be more sexually active and more proactive than girls, had more autonomy on deciding where to go, and perceived less school connection and neighborhood cohesion. Female respondents in the sex exploratory group were older and less empowered in decision-making than the general group. CONCLUSIONS: The result provides a picture of romantic and sexual behavior patterns among both gender of very young adolescents in China. Current sex education needs not only to be culturally appropriate but also to address the harm of gender inequality and stereotypes, as well as to provide accessible and supportive services to help young adolescents personalize their received information and strengthen their skills in communication, decision making, and critical thinking.

Studies on teenagers' romantic and sexual experiences would help to prevent early sex arises before it really takes place. However, such studies are limited, especially in China. The traditional culture thought that youth should not start romance before college. This study used the Global Early Adolescent Study Shanghai site baseline data collected among1776 teenagers to explore their romantic and sexual experiences patterns and identify the influencing factors. There were significant gender differences in teenagers' romantic and sexual-related behaviors. According to the multi-group latent class analysis, we classified the teenagers into three classes: the general group, the early romance group, and the sex exploratory group. The multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both boys and girls, ever had boyfriend/girlfriend and were freer to go out than the general group; while boys in the sex exploratory group were older, ever had a boyfriend/girlfriend, believed it was normal for boys to be sexually active than girls, had more freedom to go out, and had less perception of care from school adults and neighborhood. Girls in the sex exploratory group were older and less likely to make decisions on their own. Given the result we found, we call for health researchers and educators to conduct sex education programs promoting more equal gender norms and provide services to help young adolescents get right information and strengthen their skills in communication, decision making and critical thinking.

Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China.

BACKGROUND: This cross-sectional study aimed to identify adverse childhood experience (ACE) subtypes using variable- and person-centered approaches and examine the possible sex-differentiated associations with violence involvement as victim, perpetrator, and victim-perpetrator. METHODS: Adolescents aged 10-14 years in three junior high schools in Shanghai, China, were selected using a cluster sampling method in November and December 2017. Participants were surveyed anonymously using a computer-assisted self-interview approach via tablets. Thirteen items modified from the CDC-Kaiser ACE study were used to measure the ACEs. Results show subtypes as neglect, abuse, and household dysfunction by developing cumulative index score from the variable perspective and subgroups identified through the latent class analysis (LCA) from the person perspective. Logistic regression analyses were used to test the association between each ACE subtype and violence victimization and perpetration after adjusting for some demographic characteristics. RESULTS: A total of 1,700 participants were included in the final analysis. Approximately 1,322 (77.76 %) participants reported experiencing at least one ACE. The prevalence of neglect, abuse, and household dysfunction was 64.12 % (n = 1090), 61.29 % (n = 1042), and 18.24 % (n = 310), respectively. Three classes were identified through the LCA: low exposure to all ACEs (n = 854, 50.23 %), high exposure to emotional and physical abuse and neglect (n = 715, 42.06 %), and high exposure to all ACEs (n = 131,7.71 %). After controlling the covariates, experiencing abuse, neglect, and household dysfunction was significantly related to violence victimization (adjusted odds ratio [aOR] = 3.19, 3.29, 2.37, P < 0.001) and victim-perpetrator (aOR = 3.48, 4.41, 5.16, P < 0.001). Adolescent violence perpetration was only found to be associated with being neglected (aOR = 2.37, P = 0.003) and suffering household dysfunction (aOR = 3.25, P < 0.001). LCA revealed the cumulative effects of ACEs on adolescent violence victimization and perpetration. Sex-stratified analysis indicate that girls were more vulnerable to the negative effects of ACEs, with a higher risk of perpetration among girls exposed to distinctive subtypes or multiple ACEs. CONCLUSIONS: ACEs were ubiquitous and significantly associated with an elevated risk of violence victimization and perpetration during early adolescence. Future research should examine whether these associations persist over time and the intermediating mechanism from the perspectives of individual neurodevelopment, cognition and resilience ability, and social support.

The effect of COVID-19 school closures on adolescent sleep duration: an uncontrolled before-after study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected almost 1.6 billion students or more than 90% of learners globally. However, the effect of school closures during COVID-19 pandemic on adolescent sleep duration remains unclear. METHODS: We undertook a cross-sectional electronic survey in six junior and senior high schools in Shanghai, China from late June to early July 2020. We evaluated the changes of sleep duration on weekdays by comparing sleep duration hours and insufficient sleep (< 9 h for children aged 6-13 years or < 8 h for teenagers aged 14-17 years) in COVID-19 school closures and after school reopening. We also investigated possible sex differences in the changes of sleep duration. RESULTS: A total of 3265 students completed the survey, the mean age was 14.56 ± 1.99 years, 1567 (47.99%) were girls and 1344 (41.17%) were in grades 10-12. The overall sleep duration decreased from 8.88 h in school closures to 7.77 h after school reopening, and the change (difference: - 1.11 h; 95%CI: - 1.16, - 1.07; P < 0.001) was statistically significant. The prevalence of insufficient sleep increased sharply from 21.10 to 63.98%, and the change (ratio:3.03; 95%CI:2.84, 3.23; P < 0.001) was statistically significant. Besides, the changes were greater in girls than in boys. CONCLUSION: Results of this study revealed that sleep duration was longer and percentage of sufficient sleep was higher during COVID-19 school closures in adolescent students.

Correlations of impulsivity and aggressive behaviours among adolescents in Shanghai, China using bioecological model: cross-sectional data from Global Early Adolescent Study.

OBJECTIVE: To examine the correlations between impulsivity and aggressive behaviours among Chinese adolescents. DESIGN: A school-based cross-sectional study. SETTING: Three primary middle schools located in less developed communities of Shanghai. PARTICIPANTS: 1524 adolescents aged 11-16 years. MEASURES: The impulsivity was measured by Barratt Impulsivity Scale, and the aggressive behaviours were determined by self-reports. Data were collected through computer-assisted self-interview using tablets. Multivariate Firth logistic regression model was conducted to examine correlations between total, attentional, motor, and non-planning impulsivity and aggressive behaviours, respectively. RESULTS: Totally, 7.48% of participants reported aggressive behaviours toward others during the past 6 months. The proportion of aggressors among boys and girls was 10.60% and 4.18%, respectively. Results of the multivariate regression suggested the risk of aggressive behaviours was significantly increased among those with the highest tertile of total impulsivity (adjusted OR (aOR)boys=3.14, 95% CI: 1.48 to 6.65; aORgirls=3.74, 95% CI: 1.10 to 12.76) and motor impulsivity (aORboys=2.91, 95% CI: 1.46 to 5.82; aORgirls=3.57, 95% CI: 1.25 to 10.20.), comparing with those with the lowest tertile, for boys and girls, respectively. Besides, younger age, lower social cohesion and being bullied within 6 months were associated with a higher risk of aggressive behaviours among girls. Less family caring and being bullied within 6 months were associated with the risk among boys. CONCLUSIONS: The present study indicates a positive association between impulsivity and aggressive behaviours, with a more salient correlation between motor impulsivity subtrait and aggressive behaviour among both boys and girls. Furthermore, adolescents' aggressive behaviours were affected by multiple factors from individuals, family, peers and community. Comprehensive intervention strategies such as controlling the aggressor's impulsivity, helping them better channel their anger, creating a better family, school and neighbourhood environment, and providing support and services for victims of violence are needed.